Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial
| Autor: | Maya Blum, Lisa Stern, Kirsten Thompson, Cynthia C. Harper, Suzan Goodman, Philip D. Darney, Corinne H. Rocca, J. Joseph Speidel, Julia E. Kohn |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Health Knowledge Attitudes Practice medicine.medical_specialty Education Continuing Adolescent Health Personnel Psychological intervention AJPH Research law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Contraceptive Agents Female medicine Humans 030212 general & internal medicine Cluster randomised controlled trial Drug Implants 030219 obstetrics & reproductive medicine Medicaid business.industry Proportional hazards model Hazard ratio Public Health Environmental and Occupational Health United States Contraception Family planning Delayed-Action Preparations Family Planning Services Family medicine Female business On-the-job training Intrauterine Devices |
| Zdroj: | American Journal of Public Health. 106:541-546 |
| ISSN: | 1541-0048 0090-0036 |
| DOI: | 10.2105/ajph.2015.303001 |
| Popis: | Objectives. We determined whether public funding for contraception was associated with long-acting reversible contraceptive (LARC) use when providers received training on these methods. Methods. We evaluated the impact of a clinic training intervention and public funding on LARC use in a cluster randomized trial at 40 randomly assigned clinics across the United States (2011–2013). Twenty intervention clinics received a 4-hour training. Women aged 18 to 25 were enrolled and followed for 1 year (n = 1500: 802 intervention, 698 control). We estimated the effects of the intervention and funding sources on LARC initiation with Cox proportional hazards models with shared frailty. Results. Women at intervention sites had higher LARC initiation than those at control (22 vs 18 per 100 person-years; adjusted hazard ratio [AHR] = 1.43; 95% confidence interval [CI] = 1.04, 1.98). Participants receiving care at clinics with Medicaid family planning expansion programs had almost twice the initiation rate as those at clinics without (25 vs 13 per 100 person-years; AHR = 2.26; 95% CI = 1.59, 3.19). LARC initiation also increased among participants with public (AHR = 1.56; 95% CI = 1.09, 2.22) but not private health insurance. Conclusions. Public funding and provider training substantially improve LARC access. |
| Databáze: | OpenAIRE |
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